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As with all approaches to assessing and improving the quality of healthcare, it is important that we establish, as rigorously as possible, their impact and cost-effectiveness. Just as we rightly expect healthcare practice and policy to be informed by research evidence, we should expect the same for quality assessment and improvement activities that consume resources that could otherwise be spent on care. Without rigorous evaluation, we cannot know how best to improve the quality of healthcare.

With this goal in mind, we undertook a long overdue review of the research evidence of the impact of national confidential enquiries (NCEs), an approach to assessing the safety of care that has changed little since its inception about 50 years ago. We concluded by pointing out the need for more rigorous evaluation of NCEs and suggested that the value of NCEs might be enhanced by conceiving them as complementary to prospective national clinical audits.1 Mr Leigh seems to have viewed these recommendations as threats …

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